Le FortⅠ型截骨术对上颌后缩患者腭咽部结构影响的研究

Le FortⅠ Osteotomy on the Velopharyngeal Configuration of Maxillary Retrognathia Patients

目的:探讨上颌Le FortⅠ型截骨术对上颌后缩患者腭咽部结构的影响。方法:选择2007—2009年行上颌Le FortⅠ型截骨术的上颌后缩伴随下颌前突患者42例(男20例,女22例,平均年龄21.6岁),所有患者在术前、术后1周、术后1年拍摄静止位头颅定位侧位片,然后对腭咽部软组织结构指标进行测量分析。结果:上颌骨最大前移幅度为8 mm,最小为3 mm,平均前移(5.21±2.33)mm,术后1周及1年后鼻棘点与咽后壁的距离、软腭长度及软硬腭夹角较术前明显增大,而软腭鼻腔面最突点距咽后壁距离、腭垂末点距咽后壁距离及软腭厚度减小。术后1年软硬腭夹角较术后1周显著增大。上颌前移幅度与腭咽部结构变化程度间无明显相关关系。结论:上颌骨前移术后,会造成患者腭咽腔深度显著增加,可能会使腭咽闭合功能受损,但腭咽部软组织的代偿性改变会在一定程度上减轻这种损害,从而尽量维持良好的腭咽闭合功能。

Objective： To study the effect of the Le FortⅠ Osteotomy on the velopharyngeal configuration of maxillary retrognathia patients.Methods： A total of 42 patients with maxillary retrognathia and/or mandibular prognathia（20 males and 22 females,average age 21.6 years old） which underwent Le FortⅠ osteotomy and bilateral sagittal split ramus osteotomy between 2007—2009 were retrospectively reviewed.The X-ray examinations consisted of lateral cephalometric radiographs for each patient were undertaken preoperatively（T1）,one week postoperatively（T2）,and one year postoperatively（T3）,and 6 measure indexes of velopharyngeal configuration were collected and analyzed.Results： The average maxillary advancement distance was（5.21±2.33） mm.PNS-PhW,UL and ∠ANS—PNS—U had all significantly increased,and C—PhW T—PhW and UD had significantly decreased post-surgery compared with pre-surgery.No significant linear correlation was found between maxillary advancement distance and velopharyngeal configuration changes.Conclusion： Correction of maxillary hypoplasia by using Le FortⅠ osteotomy will increase the velopharyngeal cavity depth,which may impair velopharyngeal competence.The compensatory effects of velopharyngeal soft tissue may be alleviated this impairment at certain extent.